Peripheral Nervous System Examination

Eighty getconsent Entity the OR lower pus both in the Osce introduction Name abt Explain upper top off shoes song GeneralInspection Iiit ii the postural abnormalities and deformities I A muscle wasting a sea D fasciulations Tremor Small area of muscles contracting Abnormal movements Romberg's test suggest Upperlimb Tong Ask if to lower limb station separate resistance to movement w sitting comfortably Let them relaxand more their arms for them wrist flexion t extension elbowflexion t extension Do both arms increasedton rigidity Decreased tone Lowermotor have lesion never power Askthem close eyes and stick their arms out palms Titheshold arms still Look for pronator drift home winpronate withstore the sin REPEATALL ACTIONS ON BOTH LIMBS f Elbows out toside patient push upagainst resistance push down fit Bicepcurl position patient flex forearmagainstresistance extend forearm make a fist arms out fo to push patients wrist to flex position patient resist Same as last but open hand to push patients wrist 3g to flex position patient resists fingers abducted to push patients fingers adducted patient resists a fingersaddicted patient trypullapartCresist push thumbto Make ok sign 2 tryto pull Maybe ft flexion against my indexfinger out of more from list ok sign own thumb Coordination u look for past pointing Finger to nose test action tremor in out my finger a cerebellum disease put front ofthem Askthem to touch myfinger them to theirnose Repeat oer and over again repeaters move my finger to different positions FYI other hand try Ask them to pronate Supinate tap their other hand tap hand again repeatedly otherhand too if corrupted movement be Diosdadochokinesia then it would Reflexed Wohltendon hammer lightly Biceps jerk CS b hit my thumb over their biceptendon Triceps on CT my nm Brachioradialis Cs 0 at cant do damnteeth to distractthemselves Sensation Listutmatten wool to touch if it felt soft ash for 4 shoulder each location as arm of forearms Lateral palm middlepalm 6 a Do medial finger C8 inner forearm t I inner arm 72 left Right Risd'spolible neurotip and do samething but if it feels sharp instead Wam it will hurt a bit ffII.tt mu anger steam let them relax more Distal phalanx up or down ask if they felt it move up a Both Sides 4h a bit d 2mm or down and Vibration use 128N tombs fork twang it IPpittiton sternum put it on ask it vibrating fingertip ask again Askfor them to tell you when it stops vibrating on finger then hold for t stop vibrating if couldnt feel it stop tryagain goingup the arm at bony prominences Finish Higher mental function test Cranial nerve examination separate station turpentine toggling Ask if any pain Roll legs side to side handsunder bree and down lift it briskly letting it flop back Rotate the ankle around a I c slightly flex the knee mm mm checkforchnu then flick the ankle to dorsiflex then plantarflex clonus is 9tone Rapid Sustainedjerking of ankle when you flex it fast any ne power Lift entire leg up hipflexion Leg push down trip extension resist me pushing resist me pulling leg it down up Resistabduction of this Resist addiction of thigh patientkneebent they flex knee against 4 theytry straighten resistance breeagainst resistance Resist plantarflexion O resist dorsiflexion co ordination Askpatient to place legs one foots heel knee then run the heel down the shin then backupagain Otherleg too on top of other Reflexy Bet their knee to Go flexin tap patellar tendon with hammer both legs External rotate their leg and dorsiflex the ankle to stretu tendon tap the calcaneal tendon a a Babinski reflex plantar response Wan pain scratch using blunt tip from heel to sole up do not touch toes a Go around laterally watch big toe for movement flexion normal Ijgnidtown pain using using cotton wool ashfor soft tip ash for sharp L2 upper this a lowermedial thigh 23 a medial leg lateral leg us Sole of foot 51 a posterior thigh LY 52 Ignatieff distal te phalanx of bis do ankle then knee it Ktm cannot feel 12842 fork vibrate it and on big toe Chose m crown using that eyes then stop it end can lmk when you feel you see it it stop vibrating CompletingtheExamination Take full history Assess Gait cam out Romberg's test basically patient eyes are closed Highermentalfunction test upper Pws examination Cranialnerves exam will lose balance when NEURO LO GI CAL EXAMI NATI O N O F THE LI MBS – PHYSI CAL EXAMI NATI O N GUI DE UPPER LI MBS √ Comments √ Comments Power Pronator drift Shoulders – abduction Shoulders – adduction Elbows – flexion Elbows –extension Wrist – flexion Wrist – extension Fingers - flexion Fingers - extension Fingers - adduction Fingers – abduction Thumb – abduction Thumb - adduction √ Comments Coordination Finger to nose test Dysdiadochokinesia √ Comments Tendon reflexes Biceps (C5,6) Triceps (C7) Brachioradialis (C5,6) √ Comments Sensation Light touch √ Comments General Inspection Postural abnormalities and deformities Muscle wasting Fasciculation / Tremor Abnormal movements Upper Limbs Tone Check that the patient does not have any pain before starting Flex and extend hand at wrist Flex and extend arms at elbow Shoulder (C4) Lateral aspect of the upper arm (C5) Lateral aspect of the lower Pain arm (C6) Tip of the middle finger (C7) Medial aspect of hand (C8) Medial aspect of the lower arm (T1) Medial aspect of upper arm (T2) Joint position sense Vibration (using a tuning fork of 128Hz) CHDD Year 2 LO W ER LI MBS Tone Check that the patient does not have any pain before starting ‘Roll’ legs on bed Flex and extend knee Rotate ankle Test for clonus √ Comments Power Hips – flexion Hips – abduction Hips – adduction Hips – extension Knee – flexion Knee – extension Ankle – dorsiflexion Ankle – plantar flexion √ Comments Coordination Heal - shin test √ Comments Tendon reflexes Knee (L3,4) Ankle (S1) Plantar response (Babinski sign) √ Comments Sensation Light touch √ Comments √ Comments Pain Upper part of the upper leg (L2) Lower-medial part of the upper leg (L3) Medial lower leg (L4) Lateral lower leg (L5) Sole of foot (S1) Back of upper leg (S2) Proprioception Vibration (using a tuning fork of 128Hz) Completing the Examination Gait (can do this at the start) Romberg’s test